Cause and Manner of Death

Cause of death is a medical opinion which is expressed in two parts. The first is a description of the condition or conditions which directly led to death. When multiple, they are listed in reverse chronological order. The first condition listed is the immediate cause of death, i.e. the condition which caused the individual to die at that time and in that place. The last condition listed is the proximate (or underlying) cause of death, i.e. the condition which started a chain of events leading to death. In some cases, these are one and the same—for example, “Toxic effects of cocaine”. More commonly, the chain has multiple links. For instance, if an individual suffered brain injury from a fall and, while bedridden and unconscious, developed pneumonia which led to death, his or her cause of death could be listed as, “Pneumonia, due to blunt force head trauma, due to fall.”

The second part of the cause of death statement is a list of conditions which did not directly cause death but were contributing factors. For instance, the individual in the example above might have had severe emphysema and, because of this, have been at increased risk of developing pneumonia. Manner of death is a medicolegal determination that groups deaths into categories for public health purposes. It is based upon the proximate cause of death. In the example above, although the immediate cause of death was pneumonia, the proximate cause was a fall. Therefore, the manner of death is accident.

An excellent description of the five commonly used manners of death is provided by the National Association of Medical Examiners:

“Natural deaths are due solely or nearly totally to disease and/or the aging process.

Accident applies when an injury or poisoning causes death and there is little or no evidence that the injury or poisoning occurred with intent to harm or cause death. In essence, the fatal outcome was unintentional.

Suicide results from an injury or poisoning as a result of an intentional, self-inflicted act committed to do self harm or cause the death of one’s self.

Homicide occurs when death results from a volitional act committed by another person to cause fear, harm, or death. Intent to cause death is a common element but is not required for classification as homicide … It is to be emphasized that the classification of Homicide for the purposes of death certification is a “neutral” term and neither indicates nor implies criminal intent, which remains a determination within the province of legal process.

Undetermined or ‘could not be determined’ is a classification used when the information pointing to one manner of death is no more compelling than one or more other competing manners of death in thorough consideration of all available information.”